Every summer in Pakistan, the same pattern repeats. Temperatures cross 40°C, water demand surges, and the pressure in municipal pipelines drops. That pressure drop is exactly when sewage seeps into supply lines through cracks and joints — and hepatitis A and E travel right along with it.
Both viruses are waterborne, both cause liver inflammation (hepatitis means inflammation of the liver), and both are preventable. Yet thousands of Pakistani families get caught off guard each year, often dismissing the early symptoms as a routine stomach bug or heat exhaustion. By the time jaundice appears, the infection is already well established.
This guide explains how the two viruses differ, who is at greatest risk in Pakistan, and the practical steps that actually reduce your family’s exposure — including one common water habit in Pakistani households that gives a false sense of safety.
ہیپاٹائٹس اے اور ای: اہم باتیں
ہیپاٹائٹس اے اور ای دونوں آلودہ پانی اور کھانے کے ذریعے پھیلتے ہیں اور پاکستان میں گرمیوں اور مون سون کے موسم میں ان کے کیسز بڑھ جاتے ہیں۔ ان وائرسز سے جگر میں سوزش ہوتی ہے جس کی علامات میں یرقان، گہرے رنگ کا پیشاب، متلی اور تھکاوٹ شامل ہیں۔ ہیپاٹائٹس اے بچوں میں زیادہ عام ہے جبکہ ہیپاٹائٹس ای بالغوں کو زیادہ متاثر کرتا ہے، اور حاملہ خواتین کے لیے یہ خاص طور پر خطرناک ہو سکتا ہے۔ صاف اور ابلا ہوا پانی پینا، ہاتھ دھونا، اور ہیپاٹائٹس اے کی ویکسین لگوانا ان بیماریوں سے بچاؤ کے مؤثر طریقے ہیں۔
How Hepatitis A and E Spread in Pakistan
Both hepatitis A virus (HAV) and hepatitis E virus (HEV) travel through the fecal-oral route: a person ingests water or food contaminated with the feces of an infected individual. According to WHO EMRO, hepatitis A and E are typically caused by ingestion of contaminated food or water. In Pakistan, the mechanism is almost always the same — a broken or leaking water pipe that runs close to a sewage line.
Stomach infections spreading in Pakistan this summer
According to WHO EMRO Pakistan, mini-epidemics of hepatitis E occur regularly during monsoon rains and floods due to major contamination of drinking water with sewage. A published study on a 1993 to 1994 Islamabad outbreak traced the entire epidemic to a single water treatment plant malfunction, with attack rates as high as 16.3% in the worst-affected areas. Outbreaks have since been documented in Peshawar, Rawalpindi, Multan, Hyderabad, Quetta, and Karachi — every major city has had at least one recorded cluster.
A practical detail many Pakistani households miss: low-pressure tap water between supply intervals can pull soil and contaminated groundwater back into pipes through joints and micro-leaks. This means the water that comes out of your tap after a gap is not the same water that left the treatment plant.
Hepatitis A vs Hepatitis E: Key Differences
The two viruses feel similar at the start but behave differently in important ways. The table below summarises what Pakistani patients and caregivers most need to know.
| Feature | Hepatitis A (HAV) | Hepatitis E (HEV) |
|---|---|---|
| Who it hits hardest | Children under 15 | Adults aged 15 to 40 |
| Incubation period | 15 to 50 days (avg 28 days) | 2 to 9 weeks |
| Becomes chronic? | No | No (rarely, in immunocompromised) |
| Pregnancy risk | Low | High (can be life-threatening) |
| Vaccine available? | Yes — widely available in Pakistan | No commercial vaccine available |
| Recovery time | 2 to 4 weeks typically | 1 to 6 weeks typically |
| Main risk in Pakistan | Children drinking unboiled water | Adults, monsoon season, flood areas |
According to a PMC review of viral hepatitis in Pakistan, HEV is responsible for acute hepatitis in 20 to 22% of adults presenting with acute liver illness. Hepatitis A, once almost exclusively a childhood disease in Pakistan, is now increasingly affecting adults — a 2025 PMC letter evaluating data from a Pakistani tertiary care hospital (Shahid et al.) noted a clear epidemiological shift, with HAV infections rising among adults who grew up in areas with improved sanitation and therefore never developed natural childhood immunity.
Symptoms of Hepatitis A and E to Watch For
Both infections share a similar early symptom profile. The challenge is that the first few days look like a generic stomach illness, which is why many patients in Pakistan delay seeking care.
According to the WHO, symptoms of viral hepatitis may include:
- Fever (low-grade, not always present)
- Fatigue and general weakness
- Loss of appetite
- Nausea and vomiting
- Abdominal discomfort, especially in the upper right side
- Dark-coloured urine (tea or cola coloured)
- Pale or clay-coloured stools
- Jaundice — yellowing of the skin and whites of the eyes
According to StatPearls (NIH), jaundice appears in 40% to 80% of hepatitis A cases, and dark urine is reported by 68% to 94% of patients. Children under 6 years may have no visible jaundice at all, yet can still spread the virus — a fact that catches many Pakistani parents off guard.
With hepatitis E, symptoms typically last 1 to 6 weeks according to the WHO. In most healthy adults, the illness resolves on its own. The exception is pregnancy.
Why Hepatitis E Is Especially Dangerous in Pregnancy
Pregnant women in Pakistan face a disproportionate risk from hepatitis E. A published outbreak study from Islamabad recorded a case fatality rate of 11.4% among pregnant women in their third trimester, compared to a much lower rate in the general population. All four adult deaths in that outbreak occurred in women in the third trimester of pregnancy.
This is not a rare or obscure complication. According to WHO, hepatitis E can cause severe disease and acute liver failure in pregnant women. Any pregnant woman in Pakistan who develops jaundice, unusual fatigue, or right-sided abdominal pain during summer or monsoon months should be evaluated by a doctor the same day — not monitored at home.
hepatitis information and specialist care
The Jar Water Myth: A Pakistani-Specific Risk
Many families in Lahore, Karachi, and other cities rely on 20-litre water jars from private suppliers, assuming they are safer than tap water. This assumption is not always correct. A study on Faisalabad water bodies published in the Annals of Agricultural and Environmental Medicine detected HEV genotype 1 in local sewage water, and researchers noted that private water supply chains in Pakistan are not uniformly regulated or tested.
Boiling water for at least one full minute remains the single most reliable method to inactivate both HAV and HEV. According to CDC Pakistan surveillance data, drinking unboiled water was the most important risk factor identified across all hepatitis A and E cases in their sentinel surveillance system. Filtering alone without boiling does not reliably remove viruses — filters remove particles, not viruses.
For Pakistani households that use jar water, the practical advice is: boil it anyway, or at minimum use it only from suppliers who can show current water-quality certificates. Jar water that has sat in a warm room for several hours is not sterile.
How to Prevent Hepatitis A and E in Pakistan
Prevention is straightforward but requires consistency, especially during the May to September risk window.
- Boil drinking water for at least one full minute. Let it cool in a covered vessel. Do not transfer it to an uncovered container.
- Wash hands thoroughly with soap before eating, after using the toilet, and after handling raw food. A 20-second scrub under running water is the standard.
- Avoid raw or uncooked street food during summer months, particularly chaat, gol gappay, and cut fruit sold at roadside stalls where water quality is unknown.
- Vaccinate children against hepatitis A. The HAV vaccine is available in Pakistan and is part of the recommended childhood immunisation schedule. Two doses given 6 to 12 months apart provide long-lasting protection.
- Adults who have never been vaccinated and grew up in areas with improving sanitation should ask their doctor about HAV vaccination — the epidemiological shift toward adult infections makes this relevant now.
- Pregnant women should be extra cautious during monsoon months: avoid eating out, use only boiled water, and seek care promptly if any symptoms appear.
- If someone in the household is infected, they should not prepare food for others, and shared bathrooms should be disinfected daily. The virus is shed in stool for up to two weeks before symptoms appear.
how much water a Pakistani should drink in summer
Do You Need to See a Specialist?
Most cases of hepatitis A and E resolve with rest, adequate hydration, and avoiding alcohol and paracetamol (both of which place extra load on the inflamed liver). There is no specific antiviral treatment for either infection. However, some situations require prompt medical evaluation.
Consider seeing a gastroenterologist or general physician if:
- Jaundice appears (yellowing of skin or eyes)
- Urine turns dark and does not clear after 24 hours
- You cannot keep fluids down due to persistent vomiting
- Symptoms worsen after day 5 rather than improving
- You are pregnant — any suspected hepatitis in pregnancy is a medical urgency
- You have a pre-existing liver condition, diabetes, or are on immunosuppressant medication
If 3 or more of the above apply to you or a family member, do not wait — consult a specialist.
Get Expert Help from Marham
When symptoms are ambiguous — fatigue, nausea, mild abdominal discomfort — it can be hard to know whether you are dealing with a stomach infection, hepatitis, or something else entirely. A blood test (liver function tests and hepatitis serology) is the only way to know for certain, and a doctor needs to order and interpret it.
Marham connects you with verified gastroenterologists in Pakistan who consult online and can guide you on which tests to get, what the results mean, and whether you need in-person care. A short online consultation typically takes 15 to 20 minutes and can save a family several days of uncertainty.
For pregnant patients or those with existing liver conditions, an in-person evaluation is always preferable. Marham’s platform lists verified specialists across Karachi, Lahore, Islamabad, and other cities so you can find one close to you.
Frequently Asked Questions
What is the main difference between hepatitis A and hepatitis E?
Both spread through contaminated water and cause liver inflammation, but they differ in who they affect most. Hepatitis A is more common in children, while hepatitis E most commonly affects adults aged 15 to 40 and carries a serious risk for pregnant women.
Can hepatitis A or E become a chronic (long-term) infection?
Neither hepatitis A nor hepatitis E typically becomes chronic in healthy individuals — both are self-limiting infections that resolve on their own. Hepatitis E can rarely persist in people with severely weakened immune systems, but this is uncommon.
Is there a vaccine for hepatitis E available in Pakistan?
There is currently no commercially available hepatitis E vaccine in Pakistan or most other countries. A vaccine exists in China but is not widely distributed elsewhere. Hepatitis A, by contrast, has a safe and effective vaccine that is available in Pakistan.
How dangerous is hepatitis E during pregnancy?
Hepatitis E can be life-threatening in pregnancy, particularly in the third trimester. A published Islamabad outbreak study recorded a case fatality rate of 11.4% in pregnant women in their third trimester. Any pregnant woman with jaundice or suspected hepatitis should seek medical care the same day.
How long does it take to recover from hepatitis A or E?
Most people recover from hepatitis A within 2 to 4 weeks, though some cases take up to 2 months. Hepatitis E symptoms typically last 1 to 6 weeks according to the WHO. Rest, hydration, and avoiding alcohol support recovery, but no specific antiviral drug is needed for most patients.
Conclusion
Hepatitis A and E are preventable infections that Pakistan’s water infrastructure makes difficult to fully avoid — but personal habits close most of the gap. Boiling water consistently, vaccinating children against HAV, and recognising early symptoms before jaundice sets in are the three actions that make the biggest practical difference. Pregnant women and adults who have never had natural or vaccine-induced immunity to hepatitis A are the two groups with the most to gain from acting on this now, before the next monsoon season.
